All Things Lyme Blog

Study shows doctors can misdiagnose Lyme disease

Diagnosing Lyme disease can be extremely challenging as the disease mimics many other illnesses and testing is not always accurate. The authors of a new study, Accuracy of Clinician Suspicion of Lyme Disease in the Emergency Department, discovered this firsthand as they examined “the accuracy of clinician suspicion for Lyme disease in children undergoing evaluation for Lyme disease.” [1]

by Daniel J. Cameron, MD, MPH

The study included more than 1,000 children, average age of 9, who underwent evaluation for Lyme disease at 1 of the 5 participating emergency departments. The authors found that 65 out of 554 children (12%) could have been underdiagnosed.

12% of children thought not to have Lyme disease, actually had the disease, study finds.

Meanwhile, a significant number of children could have been over-diagnosed. “Of the 127 children who the treating clinicians thought were very likely to have Lyme disease (score 8–10), 39 (31%) did not have Lyme disease,” writes Nigrovic.

The concerns of under-diagnosing a patient should remind doctors of the importance of follow-up evaluations even if the doctor concludes a child is unlikely to have Lyme disease. But as the study shows, over-diagnosis can be a problem as well and doctors need to be alert in ruling out other illnesses.

It’s worth noting that the 31% of children reportedly over-diagnosed may have been an exaggerated figure since they were required to present with an EM rash or a positive 2-tier test. In actual practice, there are Lyme disease patients who never develop an erythema migrans or have a positive 2-tier serologic Lyme disease test.

In this study, the antibiotics prescribed for children who doctors suspected had Lyme disease may have interfered with development of an erythema migrans rash or a positive 2-tier test.

The study reminds us that clinical judgment can be as problematic as relying on an erythema migrans rash or 2-tier serologic test. It is always reasonable to rule out other illnesses if the doctor suspects Lyme disease. It is also reasonable not to rule out Lyme disease even if the doctor thinks the child is unlikely to have it.

1 Reply to "Study shows doctors can misdiagnose Lyme disease"

Mark van Gelder

02/16/2018 (9:33 pm)

It’s worth noting that the 31% of children reportedly over-diagnosed may have been an exaggerated figure since they were required to present with an EM rash or a positive 2-tier test.

After 6 weeks, 2-tier testing is 85-90% sensitive. Stop spreading the ridiculous myth that serological testing misses Lyme disease in the late stage.

Also, the title of your article is misleading.

The discussion about antibiotic therapy terminating the antibody production in the early phase of Lyme disease was already been held between David J. Volkman and other IDSA members and Volkman was proven wrong.

Stop recycling old outdated views on this disease and start accepting that Lyme disease isn’t the disease you ILADS quacks think it is on the basis of believes.

Dr. Daniel Cameron, MD, MPH, is a nationally recognized leader for his expertise in the diagnosis and treatment of Lyme disease and other tick-borne illnesses. For more than 25 years, he has been treating adolescents and adults suffering from Lyme disease.

Introduction

Dr. Daniel Cameron, MD, MPH, is a nationally recognized leader for his expertise in the diagnosis and treatment of Lyme disease and other tick-borne illnesses. For more than 30 years, he has been treating adolescents and adults suffering from Lyme disease.